colon and rectal cancer treatment

Many people with colorectal
cancer want to take an active part in making decisions about their medical
care. It is natural to want to learn all you can about your disease and
treatment choices. However, shock and stress after the diagnosis can make
it hard to think of everything you want to ask your doctor. It often helps
to make a list of questions before an appointment.

To help remember what your doctor says, you may take notes or ask whether
you may use a tape recorder. You may also want to have a family member or
friend with you when you talk to your doctor – to take part in the
discussion, to take notes, or just to listen. You do not need to ask all
your questions at once. You will have other chances to ask your doctor or
nurse to explain things that are not clear and to ask for more details.

Your doctor may refer you to a specialist who has experience treating colorectal
cancer, or you may ask for a referral. Specialists who treat colorectal
cancer include gastroenterologists (doctors who specialize in diseases of
the digestive system), surgeons, medical oncologists, and radiation oncologists.
You may have a team of doctors.

Methods
of treating colon and rectal cancer

The choice of treatment depends mainly on the location of the tumor in the colon or rectum and the stage of the disease. Treatment for colorectal cancer may involve
surgery, chemotherapy, biological therapy or radiation therapy. Some people
have a combination of treatments. These treatments are described below.

Colon cancer sometimes is treated differently from rectal cancer. Treatments
for colon and rectal cancer are described separately below.

Your doctor can describe your treatment choices and the expected results.
You and your doctor can work together to develop a treatment plan that meets
your needs.

Cancer treatment is either local therapy or systemic therapy:

Local therapy. Surgery and radiation therapy are
local therapies. They remove or destroy cancer in or near the colon
or rectum. When colorectal cancer has spread to other parts of the body,
local therapy may be used to control the disease in those specific areas.

Systemic therapy. Chemotherapy and biological therapy
are systemic therapies. The drugs enter the bloodstream and destroy
or control cancer throughout the body.

Because cancer treatments often damage healthy cells and tissues, side effects
are common. Side effects depend mainly on the type and extent of the treatment.
Side effects may not be the same for each person, and they may change from
one treatment session to the next. Before treatment starts, your health
care team will explain possible side effects and suggest ways to help you
manage them.

At any stage of disease, supportive care is available to relieve the side
effects of treatment, to control pain and other symptoms, and to ease emotional
concerns.

You may want to talk to your doctor about taking part in a clinical trial,
a research study of new treatment methods. "The Promise of Cancer Research"
has more information about clinical trials.

You may want to ask your doctor these questions before treatment begins:

- What is the stage of the disease? Has the cancer spread?
- What are my treatment choices? Which do you suggest for me? Will I
have more than one kind of treatment?
- What are the expected benefits of each kind of treatment?

What are the risks and possible side effects of each treatment? How
can the side effects be managed?
- What can I do to prepare for treatment?
- How will treatment affect my normal activities? Am I likely to have
urinary problems? What about bowel problems, such as diarrhea or rectal bleeding? Will treatment affect my sex life?
- What will the treatment cost? Is this treatment covered by my insurance
plan?

Surgery

Surgery is the most common treatment for colorectal cancer.

Colonoscopy.
A small malignant polyp may be removed
from your colon or upper rectum with a colonoscope. Some small tumors
in the lower rectum can be removed through your anus without a colonoscope.

Laparoscopy. Early colon cancer may be removed with
the aid of a thin, lighted tube (laparoscope). Three or four tiny cuts
are made into your abdomen. The surgeon
sees inside your abdomen with the laparoscope. The tumor and part of
the healthy colon are removed. Nearby lymph nodes also may be removed.
The surgeon checks the rest of your intestine and your liver to see
if the cancer has spread.

Open surgery. The surgeon makes a large cut into
your abdomen to remove the tumor and part of the healthy colon or rectum.
Some nearby lymph nodes are also removed. The surgeon checks the rest
of your intestine and your liver to see if the cancer has spread.

When a section of your colon or rectum is removed, the surgeon can usually
reconnect the healthy parts. However, sometimes reconnection is not possible.
In this case, the surgeon creates a new path for waste to leave your body.
The surgeon makes an opening (stoma) in the wall of the abdomen, connects
the upper end of the intestine to the stoma, and closes the other end. The
operation to create the stoma is called a colostomy. A flat bag fits over
the stoma to collect waste, and a special adhesive holds it in place.

For most people, the stoma is temporary. It is needed only until the colon
or rectum heals from surgery. After healing takes place, the surgeon reconnects
the parts of the intestine and closes the stoma. Some people, especially
those with a tumor in the lower rectum, need a permanent stoma.

People who have a colostomy may have irritation of the skin around the stoma.
Your doctor, your nurse, or an enterostomal therapist can teach you how
to clean the area and prevent irritation and infection. The "Rehabilitation"
section has more information about how people learn to care for a stoma.

The time it takes to heal after surgery is different for each person. You
may be uncomfortable for the first few days. Medicine can help control your
pain. Before surgery, you should discuss the plan for pain relief with your
doctor or nurse. After surgery, your doctor can adjust the plan if you need
more pain relief.

It is common to feel tired or weak for a while. Also, surgery sometimes
causes constipation or diarrhea. Your
health care team monitors you for signs of bleeding, infection, or other
problems requiring immediate treatment.

You may want to ask your doctor these questions before having surgery:

What kind of operation do you recommend for me?

Do I need any lymph nodes removed? Will other tissues be removed?
Why?

What are the risks of surgery? Will I have any lasting side effects?

Will I need a colostomy? If so, will the stoma be permanent?

How will I feel after the operation?

If I have pain, how will it be controlled?

How long will I be in the hospital?

When can I get back to my normal activities?

Chemotherapy

Chemotherapy uses anticancer drugs to kill cancer cells. The drugs enter
the bloodstream and can affect cancer cells all over the body.

Anticancer drugs are usually given through a vein, but some may be given
by mouth. You may be treated in an outpatient part of the hospital, at the
doctor's office, or at home. Rarely, a hospital stay may be needed.

The side effects of chemotherapy depend mainly on the specific drugs and
the dose. The drugs can harm normal cells that divide rapidly:

Blood cells. These cells fight infection, help blood
to clot, and carry oxygen to all parts of your body. When drugs affect
your blood cells, you are more likely to get infections, bruise or bleed
easily, and feel very weak and tired.

Cells in hair roots. Chemotherapy can cause hair
loss. Your hair will grow back, but it may be somewhat different in
color and texture.

Cells that line the digestive tract. Chemotherapy
can cause poor appetite, nausea and vomiting,
diarrhea, or mouth and lip sores.

Chemotherapy for colorectal cancer can cause the skin on the palms of the
hands and bottoms of the feet to become red and painful. The skin may peel
off.

Your health care team can suggest ways to control many of these side effects.
Most side effects usually go away after treatment ends.

Biological therapy

Some people with colorectal cancer that has spread receive a monoclonal
antibody, a type of biological therapy. The monoclonal antibodies bind to
colorectal cancer cells. They interfere with cancer cell growth and the
spread of cancer. People receive monoclonal antibodies through a vein at
the doctor's office, hospital, or clinic. Some people receive chemotherapy
at the same time.

During treatment, your health care team will watch for signs of problems.
Some people get medicine to prevent a possible allergic reaction. The side
effects depend mainly on the monoclonal antibody used. Side effects may
include rash, fever, abdominal pain, vomiting,
diarrhea, blood pressure changes, bleeding, or breathing problems. Side
effects usually become milder after the first treatment.

You may want to ask your doctor these questions before having chemotherapy
or biological therapy:

What drugs will I have? What will they do?

When will treatment start? When will it end? How often will I have
treatments?

Where will I go for treatment? Will I be able to drive home afterward?

What can I do to take care of myself during treatment?

How will we know the treatment is working?

Which side effects should I tell you about?

Will there be long-term effects?

Radiation therapy

Radiation therapy (also called radiotherapy) uses high-energy rays to kill
cancer cells. It affects cancer cells only in the treated area. Since this type of treatment has become more popular, radiation therapy schools in PA and around the world are now more prevalent.

Doctors use different types of radiation therapy to treat cancer. Sometimes
people receive two types:

External radiation. The radiation comes from a machine.
The most common type of machine used for radiation therapy is called
a linear accelerator. Most patients go to the hospital or clinic for
their treatment, generally 5 days a week for several weeks.

Internal radiation (implant radiation or brachytherapy).
The radiation comes from radioactive material placed in thin tubes put
directly into or near the tumor. The patient stays in the hospital,
and the implants generally remain in place for several days. Usually
they are removed before the patient goes home.

Intraoperative radiation therapy (IORT). In some
cases, radiation is given during surgery.

Side effects depend mainly on the amount of radiation given and the part
of your body that is treated. Radiation therapy to your abdomen and pelvis may cause nausea, vomiting, diarrhea,
bloody stools, or urgent bowel movements. It also may cause urinary problems,
such as being unable to stop the flow of urine from the bladder. In addition,
your skin in the treated area may become red, dry, and tender. The skin
near the anus is especially sensitive.

You are likely to become very tired during radiation therapy, especially
in the later weeks of treatment. Resting is important, but doctors usually
advse patients to try to stay as active as they can.

Although the side effects of radiation therapy can be distressing, your
doctor can usually treat or control them. Also, side effects usually go
away after treatment ends.

You may want to ask your doctor these questions about radiation therapy:

Why do I need this treatment?

When will the treatments begin? When will they end?

How will I feel during treatment?

How will we know if the radiation treatment is working?

What can I do to take care of myself during treatment?

Can I continue my normal activities?

Are there any lasting effects?

Treatment for colon cancer

Most patients with colon cancer are treated with surgery. Some people have
both surgery and chemotherapy. Some with advanced disease get biological
therapy.

A colostomy is seldom needed for people with colon cancer.

Although radiation therapy is rarely used to treat colon cancer, sometimes
it is used to relieve pain and other symptoms.

Treatment for rectal cancer

For all stages of rectal cancer, surgery is the most common treatment. Some
patients receive surgery, radiation therapy, and chemotherapy. Some with
advanced disease get biological therapy.

About 1 out of 8 people with rectal cancer needs a permanent colostomy.

Radiation therapy may be used before and after surgery. Some people have
radiation therapy before surgery to shrink the tumor, and some have it after
surgery to kill cancer cells that may remain in the area. At some hospitals,
patients may have radiation therapy during surgery. People also may have
radiation therapy to relieve pain and other problems caused by the cancer.

Nutrition and physical activity

It is important to eat well and stay as active as you can.

You need the right amount of calories to maintain a good weight during and
after cancer treatment. You also need enough protein, vitamins, and minerals.
Eating well may help you feel better and have more energy.

Eating well can be hard. Sometimes, especially during or soon after treatment,
you may not feel like eating. You may be uncomfortable or tired. You may
find that foods do not taste as good as they used to. You also may have
nausea, vomiting, diarrhea, or mouth sores.

Your doctor, dietitian, or other health care provider can suggest ways to
deal with these problems.

Many people find they feel better when they stay active. Walking, yoga,
swimming, and other activities can keep you strong and increase your energy.
Whatever physical activity you choose, be sure to talk to your doctor before
you start. Also, if your activity causes you pain or other problems, be
sure to let your doctor or nurse know about it.

Rehabilitation

Rehabilitation is an important part of cancer care. Your health care team
makes every effort to help you return to normal activities as soon as possible.

If you have a stoma, you need to learn to care for it. Doctors, nurses,
and enterostomal therapists can help. Often, enterostomal therapists visit
you before surgery to discuss what to expect. They teach you how to care
for the stoma after surgery. They talk about lifestyle issues, including
emotional, physical, and sexual concerns. Often they can provide information
about resources and support groups.

Follow-up care

Follow-up care after treatment for colorectal cancer is important. Even
when the cancer seems to have been completely removed or destroyed, the
disease sometimes returns because undetected cancer cells remained somewhere
in the body after treatment. Your doctor monitors your recovery and checks
for recurrence of the cancer. Checkups help ensure that any changes in health
are noted and treated if needed.

If you have any health problems between checkups, you should contact your
doctor.

Complimentary medicine

It is natural to want to help yourself feel better. Some people with cancer
say that complementary medicine helps them feel better. An approach is called
complementary medicine when it is used along with standard treatment. Acupuncture,
massage therapy, herbal products, vitamins or special diets, and meditation
are examples of such approaches.

Talk with your doctor if you are thinking about trying anything new. Things
that seem safe, such as certain herbal teas, may change the way standard
treatment works. These changes could be harmful. And some approaches could
be harmful even if used alone.

You may want to ask your doctor these questions before you decide to try
complementary medicine:

What benefits can I expect from this approach?

What are its risks?

Do the expected benefits outweigh the risks?

What side effects should I watch for?

Will this approach change the way my cancer treatment works? Could
this be harmful?

Is this approach under study in a clinical trial?

How much will it cost? Will my health insurance pay for this approach?

Can you refer me to a complementary medicine practitioner?

Sources of support

Living with a serious disease such as colorectal cancer is not easy. You
may worry about caring for your family, keeping your job, or continuing
daily activities. Concerns about treatments and managing side effects, hospital
stays, and medical bills are also common. Doctors, nurses, and other members
of your health care team can answer questions about treatment, working,
or other activities. Meeting with a social worker, counselor, or member
of the clergy also can be helpful if you want to talk about your feelings
or concerns. Often, a social worker can suggest resources for financial
aid, transportation, home care, or emotional support.

Support groups also can help. In these groups, patients or their family
members meet with other patients or their families to share what they have
learned about coping with the disease and the effects of treatment. Groups
may offer support in person, over the telephone, or on the Internet. You
may want to talk with a member of your health care team about finding a
support group.

The promise of
research

Doctors all over the country are conducting many types of clinical trials
(research studies in which people volunteer to take part). Doctors are studying
new ways to prevent, detect, and treat colorectal cancer.

Clinical trials are designed to answer important questions and to find out
whether the new approach is safe and effective. Research already has led
to advances, and researchers continue to search for more effective approaches.

People who join clinical trials may be among the first to benefit if a new
approach is shown to be effective. And if participants do not benefit directly,
they may still make an important contribution to medicine by helping doctors
learn more about the disease and how to control it. Although clinical trials
may pose some risks, researchers do all they can to protect their patients.

If you are interested in being part of a clinical trial, talk with your
doctor.

Research on prevention

Research is being done to test whether certain dietary supplements or drugs
may help prevent colorectal cancer. For example, researchers across the
country are studying vitamin D and calcium supplements, selenium supplements, and the drug celecoxib, in people with polyps.

Research on screening and diagnosis

Scientists are testing new ways to check for polyps and colorectal cancer.
NCI-supported researchers are studying virtual colonoscopy. This is a CT
scan of the colon. It makes X-ray pictures of the inside of the colon.

Research on treatment

Researchers are studying chemotherapy and biological therapy. They are studying
new drugs, new combinations, and different doses. In addition, researchers
are looking at ways to lessen the side effects of treatment.